BBBSMqt.org - Bigs Application Form

Big Brother Big Sister Application Form

Click below for a form to email, fax, or mail in
Print or download this Bigs Application form (can be opened in any word processor)

Please contact us if you have any problems filling out the online application.

Items marked with (*) are required to be filled out.

First Name:*

Last Name*

Middle Name*:

Maiden Name:

Email:

Home Address:*

City and Zip Code:*

Primary Contact Number:*

123-4567

Secondary Contact Number:

123-4567

Work Phone:

123-4567

Fax:

123-4567

How would you like to be contacted?*

Birth Date:* mm/dd/yyyy

Gender:*

Male Female

Religion:

Ethnicity:

Sexual Orientation:

Education Level:

Marital Status:

Number of Children:

How long have you lived in the area:

Will you be in the area for at least one year?* Yes No

In case of emergency, whom should we notify?

Possession of a driver's license is not a requirement to participate in any of our programs, but is required if you will be transporting a youth in any vehicle you are operating.

Do you have a drivers license?

Yes No

Do you have Valid Insurance?

Yes No

Who lives in your home?
NAME		AGE				RELATIONSHIP TO YOU






Home addresses for the last four years: (Current Address 1st)
1.				From (years) (ex. 1998 to 2006)
2.				From (years)
3.				From (years)
4.				From (years)
Employer: Employer Address: Occupation:				How long have you been employed at this Employer: Can we contact you at work: Yes No Work hours:
EMPLOYMENT HISTORY: Please list any job you have had in the past few years, beginning with your current employer. Please star (*) any position involving working with children. Include your reason(s) for leaving each position.
Employer	City/State		Job Title		Dates		Reason for Leaving




How long do you expect to be at your present job?
How many hours per week does your job require?				Evenings/Weekends?
Future Employment Goals:
Have there been any allegations, complaints or reports regarding your involvement in child abuse/neglect? * No Yes
LEGAL RECORD: Please list any arrests, convictions and recent traffic violations
Violation/Arrest Dates		Charge				Disposition/Result



VOLUNTEER EXPERIENCE: Are you currently volunteering or planning to volunteer in any program other than BBBS? No Yes Please list volunteer positions you have or currently hold, beginning with the most recent. Please star (*) an position involving working with children.
Organization/Contact Name		Position Responsibilities		Time Commitment Required/End Date		Phone Number



Prior to your in-person interview, we would like you to answer the questions below. Parents of youth in our programs will often ask us questions about someone with whom their child will be matched. We will only release information to a parent with your expressed permission. The information you give will also help us make a better match for you and assure we can support you during your involvement with our programs.
Please list any hobbies, interests and or skills:
Please list any clubs, organizations or groups with which you are affiliated:
Are you experiencing any physical or mental health problems? No Yes				If Yes, please explain:
*Do you have any guns or ammunition in your home?No Yes** (If yes, we will discuss what safety precautions are necessary.)
Do you have any pets?* No Yes				If Yes, please list:
How did you learn about Big Brothers Big Sisters?*
Have you ever been, or applied to be a Big Brother or Big Sister?* Yes No If Yes, Where/When?
Please list members of Big Brothers Big Sisters with whom you are acquainted:
Please list your previous experience with youth:
Why do you want to be a Big Brother/Big Sister?*
Which program(s) are you interested in?

REFERENCES (Please complete three references: )

Please list three references that have known you well for at least one year. Please do not list more than one co-worker/employer & no more than one family member.

Reference 1 :
name:	address:	city:	state:
phone: (xxx)xxx-xxxx	relationship to you:	email:	zip:

Reference 2 :
name:	address:	city:	state:
phone: (xxx)xxx-xxxx	relationship to you:	email:	zip:

Reference 3 :
name:	address:	city:	state:
phone: (xxx)xxx-xxxx	relationship to you:	email:	zip:

I understand that:

The references I listed may be contacted by mail, telephone, or email;
This application in no way obligates me to perform any volunteer services;
The information I provided may be used to conduct a background check, to include driving records check, criminal background check, and other records where required by local, state, or federal law for volunteers working with youth;
Big Brothers Big Sisters of Marquette and Alger Counties, Inc. (BBBS) is not obligated to match me with a youth;
As part of BBBS's enrollment process, I will be asked to provide additional personal information prior to making any recommendations for my assignment; and,
Collected information may be shared with the parent/guardian of the child with whom I may be matched with.

By submitting this form, I agree to the above statements. Submitting this form signifies an electronic signature that you agree to the above.
Type your initials in the box if you agree